Robotic stereotactic radiotherapy for liver oligometastases from colorectal cancer: a single-center experience

  • Marco Vernaleone
  • Pierluigi BonomoEmail author
  • Vanessa Di Cataldo
  • Calogero Saieva
  • Laura Masi
  • Isacco Desideri
  • Daniela Greto
  • Giulio Francolini
  • Carlotta Becherini
  • Lorenzo Livi



To report on the safety and clinical benefit of robotic stereotactic radiotherapy (SBRT) for liver oligometastatic colorectal cancer (CRC).


Robotic SBRT was applied to oligometastatic CRC patients, defined as having 1–4 liver metastases and absent or controlled extrahepatic disease. The intended prescription dose was 37.5 Gy in three fractions. Treatment efficacy was estimated by clinical benefit rate (CBR), progression-free survival (PFS) and overall survival (OS). Toxicity was graded according to CTC-AE scale, v. 4.03. Regression analysis was performed to search for the presence of any predictive factors.


Between 2012 and 2017, 38 patients (66 lesions) were irradiated. The median delivered biological effective maximum dose (maxBED10) was 142 Gy. At a median follow-up of 11.8 months (range 3.2–58.8), the 1- and 2-year OS were 67.3% and 44.1%, respectively. Actuarial LC rates for all patients at 6 and 12 months were 64.2% and 60.4%, respectively. Local or distant progression occurred in 28 (77.8%) patients, with a 1- and 2-year PFS of 19.3% and 12.2%, respectively. The CBR was 71.4%, with no significant association with maxBED10. At multivariate analysis, the presence of extrahepatic disease had a detrimental impact on PFS (HR 3.98, 95% CI 1.77–8.93; p < 0.001) and OS (HR 3.58, 95% CI 1.06–12.07; p < 0.04). No acute grade 3 gastrointestinal toxicity was observed.


Our analysis underlines the importance of patients’ selection to identify the oligometastatic scenario most likely to benefit from SBRT. Prospective studies are needed to further assess its role among locoregional treatment options for liver metastases from CRC.


Liver metastases Stereotactic body radiotherapy Colorectal cancer Oligometastases 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

Informed consent was obtained from all individual participants included in the study. Ethical Committee approval was waived in view of the retrospective nature of our study.

Supplementary material

11547_2019_1042_MOESM1_ESM.docx (784 kb)
Supplementary material 1 (DOCX 784 kb)


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Marco Vernaleone
    • 1
  • Pierluigi Bonomo
    • 1
    Email author
  • Vanessa Di Cataldo
    • 2
  • Calogero Saieva
    • 3
  • Laura Masi
    • 2
  • Isacco Desideri
    • 1
  • Daniela Greto
    • 1
  • Giulio Francolini
    • 1
  • Carlotta Becherini
    • 1
  • Lorenzo Livi
    • 1
  1. 1.Radiation Oncology, Azienda Ospedaliero – Universitaria CareggiUniversity of FlorenceFlorenceItaly
  2. 2.Cyberknife Center, Istituto Fiorentino di Cura ed Assistenza (IFCA)University of FlorenceFlorenceItaly
  3. 3.Molecular and Nutritional Epidemiology UnitCancer Prevention and Research Institute (ISPO)FlorenceItaly

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